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Case:Oscar
Diagnosis and original treatment Oscar was diagnosed with diabetes on July 27, 2005. He was prescribed Lantus at 2U bid and was given Purina DM dry and canned food. We were told that Oscar was too high-stress at the vet to do curves, so we would only be doing fructosamine tests every 3 weeks. I took all of this in, felt very overwhelmed, but realized it was something we could deal with. We gave the 2U bid for 3 weeks, then took Oscar in for a fructosamine test. We were told that he was still in the poorly regulated range and to increase his dose to 3U bid. We kept him at this dose for another 3 weeks, then had another fructosamine test done. He was still in the higher range, but slightly lower. The vet told me to increase Oscar's dose to 4U bid. At this time, I was starting to read articles on felinediabetes.com and had discovered FDMB. I was starting to be aware of better treatment options, but was still learning. I asked our vet about hometesting and he discouraged it. I also asked about different food, as I had heard about Wellness and Fancy Feast being fed for diabetes. Oscar was throwing up the DM canned a lot and I had already cut out the dry food thanks to FDMB. The vet was okay with a switch to Wellness. Hometesting begins, treatment changes I decided to start hometesting the second the vet told me to give Oscar 4U bid. I knew that something was wrong. It just did not sound right for him to get so much insulin. I started testing and kept the dose at 3U. I told the vet about it, but he still insisted that I increase to 4U bid. I caved under his authority and increased the dose. I did a curve on the second day of the 4U dose. Luckily I did, because his numbers dropped all day and he was in hypo range by the time he was due for a shot. Had I not been hometesting, I would have given Oscar 4 units of Lantus when he had a bg of 46! I don't think he would have survived the night. This was in mid-September 2005. This is when I realized that it was up to me to treat Oscar's diabetes, not the vet. Under the direction of peers on FDMB, I reduced Oscar's dose to 2U bid and started to see better numbers. He actually required further reduction to 1.5U and then 1U. We reduced to .5U bid at one point, but that was not quite enough. We spent October and November going between .75 and 1U bid and Oscar's numbers were rarely over 250. He was doing much better overall. Medical emergency and starting over On Thanksgiving, 2005, disaster struck. Oscar would not eat and was incredibly lethargic with his third lids showing. After a moment of panic and tears, I rushed him to the emergency vet at the University animal hospital. His BG was 220 that morning at home and was also 220 at the vet. After a day at the hospital, they could not figure out what was wrong. I asked if they had checked for ketones, and they had not. After checking, it was confirmed that he had full-blown DKA. Oscar had to stay in intensive care for 6 days before the ketones were gone. It was also discovered that he had pancreatitis, which may have brought on the ketones. His pancreas was visibly inflamed in the ultrasound that they did on him. It was decided that a diet change was in order. We switched Oscar off of Wellness, which is high in fat. While it has not been confirmed, high fat diet could be a contributer to pancreatitis so we decided better safe than sorry. Oscar now eats low-fat Fancy Feast and some flavors of Merricks. I have noticed that he also throws up less on these foods. Once we changed Oscar's diet and had ketones on the brain, Oscar's glimpse of regulation went out the window. We used boosters of R insulin for a few days after he came home from the hospital to get him out of the 400's, then switched to tid dosing of Lantus. This could have worked to get him regulated if no one had jobs in our house! We had to get Oscar back on bid dosing due to schedule conflicts. This is when things went south. Preshots were consistently in the 300's and the dose was fluctuating between 1.5 and 3U bid. The Lantus never seemed to work the same way twice and it was extremely taxing on all of us to be testing all the time and stressing over what to do about his dose. On one day a dose would not do anything. The next day, it would be too strong and he would go too low. There was no rhyme or reason to his reaction to the insulin, so regulation slipped out of our hands. Switch to Levemir Once we heard that Levemir was coming to the US and was available in Canada, we decided to switch. Something had to be done soon. We were almost out of Lantus and would have either had to buy another 5 month supply or switch to something else. Since we are currently between vets, we could not consult any on this. We ordered Levemir and decided to give it a try. We could always get that refill on Lantus if it was a flop. 3/7/2006: Oscar has had 2 injections of Levemir so far at 1U bid. His first preshot after getting a dose of Levemir the night before was 176. This is the best number we have seen in a long time. I am hoping that this is the insulin for Oscar. Category:Male cases Category:Feline cases Category:Levemir cases Category:Lantus cases Category:Glucose toxicity casesCategory:Difficult regulation cases Category:low-carb cases Category:medium-carb cases Category:Ketoacidosis cases Category:Other infection cases Category:Pancreatitis cases Category:Tight Regulation cases Category:Feline male cases Category:Feline medium-carb cases Category:Feline difficult regulation cases Category:Feline ketoacidosis cases Category:Feline other infection cases Category:Feline pancreatitis cases Category:Feline glucose toxicity cases Category:Feline Levemir users